Federal Personnel

The Bureau of Indian Affairs was responsible for the health care of Native Americans until 1955, when Congress gave the Surgeon General, then the head of the Public Health Service, that duty. This briefing report provides information on the Public Health Service Commissioned Corps officers and others who provide health care to Native Americans through the Indian Health Service or tribal associations. GAO discusses (1) Corps officers' historical involvement in providing health care to Native Americans; (2) the extent to which Corps officers and non-Corps providers participated nationally in providing health care to Native Americans in fiscal year 1996; (3) the procedure for filling health-care provider vacancies in parts of Alaska, Arizona, New Mexico, and Oklahoma and the number of vacancies filled by Corps officers; (4) the way that tribal representatives, Indian Health Service officials, and medical facility staff perceived Corps and non-Corps providers and the effect on Native American health care that they anticipated from converting Corp officers to civil service status; and (5) changes in the Native American health care system that might affect those providing health care to Native Americans, whether Corps or non-Corps personnel.

GAO noted that: (1) the Bureau of Indian Affairs (BIA), in the Department of the Interior, was responsible for Native American health care until 1955; (2) Commissioned Corps officers were detailed to BIA to provide Native American health care from 1926 until 1955 and have been a part of IHS since its creation; (3) GAO's analysis of FY 1996 IHS and tribal data for 6,260 health care providers nationwide in 6 professions--physician, registered nurse, dentist, pharmacist, engineer, and sanitarian--in the Native American health care system showed that about 46 percent were federal civil service employees, and about 31 percent were Corps officers; (4) the remaining providers were nonfederal employees directly hired by tribes or Alaska Native health care associations; (5) to fill 139 health-provider positions between July 1, 1995, and June 30, 1996, in the areas GAO visited, IHS and tribal governments generally used a competitive selection process; (6) Corps officers filled 36 of the 139 recently filled vacancies; (7) of the 36 vacancies, only Corps officers applied for 17 of them; (8) interviewees' perceptions of health care providers varied; (9) of those expressing an opinion, most said they saw no difference between the skills of Corps officers and others providing health care to Native Americans; but most interviewees perceived Corps officers as being more dedicated than non-Corps providers; (10) further, most IHS officials, medical facility staffs, and tribal representatives said that converting Corps officers to civil service personnel system might have negative effects in terms of costs and health care in their areas or facilities; (11) fewer interviewees predicted no negative impact resulting from the Corps' conversion to another personnel system, while others said any impact would depend on the extent to which Corps officers make the transition to a non-Corps system; (12) about one-half of the interviewees preferred Corps over non-Corps health care providers; (13) many said that having Corps officers provide health care was less costly to them than using civil service or direct-hire providers and that civil service employees caused an administrative burden; (14) large-scale changes are occurring in the Native American health care system; (15) tribes are moving toward administering their own health care facilities and resources; and (16) although some tribes are planning to replace Corps or civil service providers with tribally hired medical personnel, others said they anticipate a continuing need for the Corps.